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Midlevel Dental Providers

The Massachusetts Dental Society believes that rather than creating a two-tier delivery system, the Commonwealth needs a thoughtful approach to address patient issues like access to high-quality care. That is what will advance oral health care across Massachusetts.

MDS Position Past and Present

The Massachusetts Dental Society Board of Trustees has tracked this issue for years and examined the impact of this legislation both locally and nationally over the last several months. As a result, the Board has voted to oppose the creation of midlevel dental providers in the Commonwealth of Massachusetts. 

The MDS will oppose any pending legislation that may include language to create this new tier of dental professionals in Massachusetts, including “An Act Investing in the Future of Our Health,” filed by the Baker Administration in 2022. The MDS believes that midlevel providers are an expensive, inefficient solution to the very real problem of oral health access. The focus here in the Commonwealth should be on proven, evidence-based, cost-effective solutions.

In 2019 the MDS supported a comprehensive, compromise midlevel legislation, “An Act to Improve Oral Health for All Massachusetts Residents.” This legislation would have enacted commonsense requirements to protect patient safety and provided oral health education. The current legislation and the climate of the dental profession in 2022 are different. Therefore, the MDS Board of Trustees has altered their position. The pandemic, staffing shortage, inflation, economic pressures, and lack of evidence supporting the benefits of midlevel providers were factors in this decision.

Why This Position

The MDS Board of Trustees examined several factors when determining the position.

1. Massachusetts does not suffer from a shortage of dentists. Creating a new provider misses the point. The same challenges that rural and underserved communities face in attracting dentists apply to dental therapists. There is nothing to suggest that a midlevel dental providers would behave differently from a dentist in choosing where to practice.

2. Midlevel providers are not required to reach the same level of education as practicing dentists. Utilizing such providers to care for underserved patients is not economically feasible or in line with the prevention model. In some states, midlevel providers are allowed to work independently doing irreversible procedures without the direct supervision of a dentist.

In the interest of public health, the MDS affirms that the dentist is the only dental provider that should perform the following functions: 
  • Diagnosis and treatment planning
  • Prescribing work authorizations
  • Performing surgical/irreversible dental procedures>
  • Prescribing drugs and/or other medications
3. There is no data to suggest that oral health outcomes, access to care, or cost of care improve in any place where dental therapists have practiced. That includes Minnesota, as well as prior tribal pilot programs in Oregon and Washington.

Access to Care Solutions

Massachusetts needs to advance holistic solutions to challenges associated with oral health care. These solutions should focus on underserved populations, provide appropriately trained and supervised professional care, and address socio-economic barriers to seeking dental care. The Massachusetts Dental Society believes that a comprehensive, multifaceted approach is needed to address the oral health care issues facing the Commonwealth. The MDS will continue to work with civic leaders on policies that expand peoples’ access to care and protect the quality of care patients receive.